Parental Fear Blocks HPV Vaccination for Teens

Parents increasingly say they are worried about the safety of the human papillomavirus (HPV) vaccine and don't intend to vaccinate their teen daughters, a new study found.

In an analysis of national survey data, more than 40 percent of parents reported in 2010 that they did not intend to vaccinate their adolescent female children with the HPV vaccine, according to Dr. Paul Darden of the University of Oklahoma Health Sciences Center in Oklahoma City and colleagues.

At the same time, doctors are increasingly recommending the vaccine, the authors wrote in the April issue of Pediatrics.

But there is no similar pattern for two other vaccines aimed at adolescents, Darden and colleagues reported.

They used data from the National Immunization Survey of Teens from 2008 through 2010 in an effort to understand why some teens are not up to date on vaccinations.

The findings suggest there may be a "need for interventions beyond clinician recommendation," the researchers concluded, including such things as social marketing campaigns.

But Dr. William Schaffner of Vanderbilt University in Nashville said other reports have found hints of "provider hesitancy" that might still be playing a role.

In some cases, he told MedPage Today, doctors might be delaying discussions with parents until later in the teen years.

"Pediatricians are letting it go in the early teens years and bringing it up only later," he said. "Then we're missing some teens because they tend not to see the doctor as frequently in the late teens as they do around 11, 12, and 13."

"Pediatricians really do need to continue to be vaccine advocates," he added.

In the survey, parents who said their teens were not vaccinated for tetanus toxoid, diphtheria toxoid, and acellular pertussis/tetanus toxoid and reduced diphtheria toxoid (Tdap/Td) and quadrivalent meningococcal conjugate vaccine (MCV4) were asked for their reasons.

Parents who said their daughters had not had the complete HPV vaccine series were asked if they intended to get them vaccinated; if they said no, they were asked for reasons.

For Tdap/Td and MCV4, the most frequent reasons for not vaccinating were the same -- "not recommended" by the doctor and "not needed or not necessary."

For HPV, the most frequent reasons included those same reasons but also showed an increasing concern for safety.

The proportion of parents who replied they were worried about "safety concerns/side effects" rose from 4.5 percent in 2008 to 7.7 percent in 2009 to 16.4 percent in 2010.

In the last year, worry about safety and side effects approached the level of the most common reason -- "not needed or not necessary" -- at 17.4 percent.

Parents reported that their doctors increasingly recommended all vaccines, including the HPV medication, rising from 46.8 percent in 2008 to 52.4 percent in 2010.

Despite that, the intent to skip the HPV shots rose from 39.8 percent in 2008 to 43.9 percent in 2010, Darden and colleagues found.

The study had some limitations. The cross-sectional survey compared three distinct cohorts across multiple years, and the authors focused their analyses on the parent survey and parental reporting without verifying vaccination status through the provider survey.